Provider Demographics
NPI:1134998230
Name:BERRIEN, LEIGH (APRN)
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:
Last Name:BERRIEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LEIGH
Other - Middle Name:BERRIEN
Other - Last Name:BAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:15 SEASIDE CT
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-4608
Mailing Address - Country:US
Mailing Address - Phone:203-215-0470
Mailing Address - Fax:
Practice Address - Street 1:YALE NEW HAVEN HOSPITAL
Practice Address - Street 2:1450 CHAPEL STREET
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-215-0470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-29
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12.006190364SA2200X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health